Club409

Any of you CS doods know somebody still in school here whose DB skillz you would vouch for and would have the time to look into/consult on a project or at least give me an estimate of the size of the theoretical undertaking? Here's my idea fyi (i'm sure it's similar to many already out there but just toilet brainstorming)

so the deal is that the Grady ER has a really crappy system of keeping up with patients - they write out all the names on a big whiteboard (i'll take a pictures at work today) and critical information such as ordered procedures complaints what doctors are assigned to them is scrawled illegibly in spaces too small. on top of that beds are arranged in nearly random order filling up the hallways and hanging out under numbers written on printer paper and taped to the wall above - making 'hall spots'. some of these hall spots are permanent and some are temporary like spot 1.a.II where somebody is just standing in between two beds because there is simply no room. when a physician orders a lab they are putting blind faith in an entirely paper system - write the order on a form give it to a nurse guy who may or may not enter it into a computer system before losing it - then some other person comes to get the patient after finding where the hell they are from the white board and drags them back to get said xray which may or may not get done depending on whether the order got through and was in the perfectly right format. the other day a patient got taken back to xray for an hour finally came back and like two hours later it was discovered that the xray hadn't been taken becouse some box somewhere hadn't been checked right and nobody felt like telling anyone. hmm . . . so overall there is absolutely NO information available electronically except the history of the patient from past hospital visits and what information is entered whenever a chemistry lab upstairs finishes its analysis (no info on whether the blood got drawn got upstairs is being worked on etc)

basically the whole thing needs revamp. to solve illegibility and for integration i want to use some kind of smartboard - information can be entered thru dropdown menus for legibility and when it cannot people can resort to writing. pda's which most doctors have already and could be extended to say the head nurse could be the means of consolidating important information on the go and displaying information that is sensitive (such as full names actual tentative diagnoses) and allowing authorized people to change the patient's status/etc. patients already have wristbands with bar codes on them for identification purposes (gives the MR# - the unifying Medical Records number for that patient and all his already electronified information) that could be somehow read by a pda appendage or given rfids or something. so that is to say that there already is a massive probably dinosauricly coded database of patient info in place but it is only usefuly for patients in the hospital proper and (again) for viewing lab results *pant* BUT this system is not useful at all to the ER staff which move too fast to enter large amounts of patient information. What is needed is a system that can painlessly collect the information most important to emergent and inpatient (that means patients going into the hospital to stay for a while) situations and collect it primarily from information already being recorded electronically and otherwise (i.e. the whiteboard radiology request info that usually just travels from the nurse's desk straight to the radiology peeps in the back).

*whew* ok so that's my basic schpiel (sp? eh whatever) what i REALLY need is some really smart and database-fluent dude to hang out with me a few days at the ER and get a solid idea of what the information needs of the movers and shakers are and what the possible information sources and communication solutions are.

Here's my notepad/brainfart summary. Thanks for whoever was lame enough to read all this :-D (PS sorry about the formatting - stupid notepad)

SmartBoard/PDAboard
- Incoming patients section
- info from triage - what zone vitals (entered by emt? only on pda)
- if known chief complaint (PDA only)
- name can be drug to permanent hall spot or new hall spot section (via
board or authorized person only - chg nurse/res att.?)
- Current Patients section
- incoming time/time in ER - turns colors after certain amt of time w/o reset?
- complaint code (board) or chief complaint/DD (pda only updated by
assigned res or att.)
- procedures- status updated - updatable from auth PDA board or anc.serv.
- labs - appears when ordered update in status (color change/prog
bar?) when fluids collected when samples reach lab (updates during

lab/ETA?) when done
- radiology - updated when order made/recieved/image taken/film
avaliable
- EKG - upd when ordered/in prog/done
- assigned attending
- assigned resident(s)
- dropdown summaries
- option to view all staff associated with patient - staff
performing anc. serv res att.
- Staff section
- present nurses/res/att. kept updated - sign in/out w/rfid?
- when signing out - reminded of patients still assigned - option to
transfer patient to new res. w/mutual permission
- dropdown summaries
- view patients related to staff member
- time in/time scheduled out
- backup - recursive systems that save same info?
- at least one dedicated machine to save board state which could be printed and written up on dry-erase (on wheels) in emergency
- primary editing format will be drop down menus for ease of selection
- always 'other' option for unpredicted data entry
- grid of patients can change size to allow for more patients/be more visible

ZoneMap
- section on board - button on current patient name will highlight bed
- when new bed created on patient list and number given bed icon on map can be moved/oriented
- vice versa - bed can be created on map moved/oriented and named automatically
- PDA zonemap - no modification (except by auth?) - but select patient name
and be shown location on map or select bed on map and get patient
name/info

Charts - some sort of rfid to know where charts are or at least when they are
or are not in their home bins? can be reported to PDABoard

PDABrief
- on PDA (or on board - dropdown section?)
- rather than list of patients page with one patient and basic info
- MR# real name DD hospital visit Hx (flags? - name flag/danger?)
- prisoner names viewable only to auth.
- procedures and their status

STATBoard?
- how could this integrate with/aid STATPacking?

other concerns
- how to integrate with ancillary serv? (EKG labs radiology)
- can't take significant time or effort or won't happen
- where is data already collectable from?
- patient wrist bracelets already made - use rfid to quickly identify/get

MR# -> PDABrief?
- limit information used by system to
a) information already entered into a computer somewhere
b) information easily and quickly entered in a convenient location
without disruption of normal operation
c) information entered on the board
- charts still most reliable source of info and people will not write this
stuff twice
- system MUST be encrypted and proveably so
- information can only go to pda's of physicians/nurses etc currently
active in ER and MAC add assigned to that person

ok so here is what I have from an hour or so of looking at what you've typed up. I have no idea what their existing system looks like but you're right it's most likely very primitive. Depending on what it looks like it might be possible to write a script to migrate the old system to new one; altenatively it would have to be done manually. :T Another option would be to let the original system co-exist. Any new illnesses reported would be inserted into the new system and the system would have to check both the new and old systems for anything in the past. Reporting information from the old system might be problamatic but once again this all depends on the current setup.

Obviously what I have provided is only a rough (and high-level) sketch of what would be required and many of the elements of your solution are not captured here (such as the radiology and EKG records). Although most of what is missing is not data related but rather software related such as creating the GUI to implement your ZoneMap idea. There are other details such as what information would be required for a patient that I am not familiar with but you might be able to fill in some of those gaps.

There also many issues that must be resolved. For example if you want to use smartboards to write on you would have to get projectors to display a gui on the board. You could use rear-projection smartboards but they take up a lot of space and are significantly more expensive (as far as I know). Connectivity is another issue. Do they have some kind of existing wireless network? If not the PDA solution would not be practical until a wireless infrastructure is put into place. This is a problem because unless the doctors can acquire updates on-the-fly (as opposed to having to go to a work station and docking) they probably won't use the new system.

The application layer could be very simple to facilitate speed. Perhaps asking as series of binary questions and more questions might be asked depending on the answer. Such as
1. Emergency? Yes No
(if yes) 1a. (ask more details about the emergency)
(if no) (goto 2).
2. Has the patient been here before? Yes No
(if yes) 2a Input MR# :
(if no)
2b. Insured? Yes No
2c. Allergies? Yes No
(ask details)
2d. Taking Drugs? Yes No
(ask details)
2e. (other details)

The order of the questions and the detail that is acquired would obviously depend on how they operate right now. I haven't read through all of your suggestions in detail but i'll give you an udpated diagram when I have more time.